Suboptimal delivery of the volume of fluid needed for resuscitation of critically injured patients can have a deleterious impact on clinical outcomes. This project will develop software and associated hardware systems to guide and perform fluid therapy in critically injured patients. This project leverages our multidisciplinary expertise (anesthesiology, surgery, physiology, engineering and statistics) and substantial translational research as evidenced by our published animal studies and preliminary clinical testing. We have three sequential hypotheses: 1. Decision-Assist algorithms and closed-loop control of fluid infusion rates produce tighter control of urinary output to normal, "target" levels. 2. Tighter control and normalization of urinary output in burn patients reduces 24- and 48-hr total fluid volume infused, and the associated net fluid balance (i.e., infused minus losses). 3. Reductions in total volume loading and net fluid balance improve clinical outcomes. We will address these hypotheses with four specific aims: 1. Develop the software and assemble hardware systems for automated fluid balance monitoring, resuscitation-displays and decision-assist recommendations. 2. Test clinical utility of the resuscitation-displays and the efficacy of decision-assist recommendations for the first 48 hours of burn resuscitation. 3. Develop rule-based algorithms to implement additional diagnostic tools, and recommend interventions when a patient is a non-responder to fluid therapy. 4. Perform a safety-efficacy trial of fully automated continuous closed-loop resuscitation with physician override. If shown effective, decision-assist and closed-loop algorithms could allow the exportation of medical expertise to caregivers lacking advanced burn care experience, greatly improving the chances of patients'survival and optimum recovery from their injuries. PUBLIC HEALTH RELEVANCE: Infusion of IV fluids can save the lives of victims of trauma, burns and after major surgical procedures. We are developing smart systems for delivering fluid therapy in intensive care units and operating rooms. Our resuscitation systems monitor a patient's vital signs and automatically administer fluid therapy by controlling the IV pump. Because the computer can monitor the patient on a minute-by- minute basis without error, there is less chance of complications due to under-resuscitation or fluid overload.